What is a Medical Billing Clearinghouse? скачать в хорошем качестве

What is a Medical Billing Clearinghouse?

When you schedule a doctor's appointment there are three things they typically ask you. Can you guess what they are? If you guessed the name, date of birth, and insurance provider you guessed right. They ask you for this information because it goes into a patient management system. Once the information is added to this system, the revenue cycle begins. Ever wondered how medical facilities manage patient data, insurance claims, and billing all at the same time? It's all possible because of medical billing clearinghouses. But what exactly is a medical billing clearinghouse? Let's break it down. Let's start with just the definition of a clearinghouse. A clearinghouse is an agency or organization that collects and distributes something, especially information. They have the resources to distribute payments, enforce security measures, and monitor transactions or statements. It ensures all elements of a deal or transaction follow the rules and that there's no funny business going on. Now what is a medical billing clearinghouse? A medical billing clearinghouse, more often referred to as a medical claims clearinghouse assists medical billers and healthcare organizations in processing and managing thousands of patients insurance claims and billing. A medical billing clearinghouse is essentially the middleman between healthcare providers and insurance companies. This type of clearinghouse makes sure there are no mistakes in the insurance claims or in the medical bills. Because medical billing clearinghouses are working with PHI or protected health information, they must follow certain regulations like the Health Insurance Portability and Accountability Act, also known as HIPAA. Medical billing clearinghouses are important for the provider's profits. The provider is the doctor or medical professional that administers care. A common issue in the revenue cycle of medical practices is denied insurance claims. In 2021, 17% of in-network claims were denied. A denied claim means a delay in the provider's profit. You wouldn't want to work for free right? Didn’t think so. This is why a clearinghouse is so important. If a claim gets denied, it needs to be corrected, submitted and go through the approval process again. But, this process can take anywhere from 15 to 45 days. Meaning if a claim is denied even once, the provider will experience a significant delay in receiving revenue. Denied claims result in huge revenue loss, even if they’re approved upon resubmission. Besides, handling denied claims consumes more time and energy compared to getting them approved the first time. So you might as well do it right the first time and utilize a clearinghouse. A Medical billing clearinghouse's goal is to not only help with the submission of claims, but also minimize denied insurance claims to maximize the provider's profits. Clearinghouses shrink the number of denied claims through claim scrubbing. Claim scrubbing is the validation checks the clearinghouse performs before it is sent to the insurance provider…almost like a spell check! This improves the claim's odds of getting approved and the provider gets paid on time! Have you ever waited for months to see your primary care doctor or dentist? I know I have. Now imagine if your doctor had to do hours and hours of paperwork after each patient. If this was part of their job description, you would never get that appointment. Regardless if you’re a payer, provider, or just a patient, you’re a part of this never-ending cycle. Now you see how much of a necessity a medical billing clearinghouse is. ►Reach out to Etactics @ https://www.etactics.com​ ►Subscribe: https://rb.gy/pso1fq​ to learn more tips and tricks in healthcare, health IT, and cybersecurity. ►Find us on LinkedIn:   / etactics-inc   ►Find us on Facebook:   / ​   #MedicalBilling #Clearinghouse